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Adnexitis: inflammation of the fallopian tubes and ovaries
Inflammation of the female pelvic organs usually occurs in combination. This also applies to adnexitis, which is an inflammation of the fallopian tube and ovary. Affected women are mostly sexually active and of childbearing age. Possible symptoms are similar to typical menstrual symptoms and the inflammation is not always easy to detect for other reasons. Most of the triggers are infections caused by rising bacteria that have to be treated with antibiotics. Without treatment or with failed therapy, chronic courses and severe complications can follow.
The medical term adnexitis describes inflammation of the ovary (oophoritis) and fallopian tubes (salpingitis), the so-called appendages (adnexa) of the uterus. The clinical picture is one of the inflammatory diseases of the female pelvic organs (English: pelvic inflammatory diseases, in short: PID), which are also generally referred to as abdominal inflammation or pelvic inflammation. Inflammation of the internal female genital organs almost always occurs in combinations and not in isolation.
A basic distinction is made between acute and non-healed chronic adnexitis. Mostly women of childbearing age are affected, although women who have not yet given birth to children develop this infection significantly more often.
In acute inflammation, the body typically reacts with sudden, severe pain in the lower abdomen that occurs on one or both sides and can also radiate to adjacent regions of the body. The symptoms often begin immediately after the menstrual period and are also similar to the non-illness-related period pain. In many cases, the following symptoms are reported:
- Ovarian pain,
- Abdominal pain (acute abdomen),
- Abdominal pain,
- Groin pain,
- Flank pain,
- Back pain,
- Sacrum pain.
In addition, there may also be other complaints, such as discharge (fluor vaginalis), nausea and vomiting, dizziness, fever and an impairment of the general condition.
If there is also spotting (bleeding outside the rule), this usually indicates an infection with chlamydia.
With the chronic form, relapses of these acute symptoms can occur again and again or there are rather unspecific complaints in the lower abdomen over a longer period of time.
As a rule, adnexitis is triggered by a bacterial infection, which is often based on different types of bacteria. In many cases, for example, gonococci, Escherichia coli or other enterococci as well as the participation of chlamydia (Chlamydia trachomatis) can be detected.
This is usually an ascending infection. So-called ascending germs reach the ovary after inflammation of the vagina (colpitis), the endometrium (endometritis) and the fallopian tube (salpingitis).
Women are particularly susceptible to these infections during ovulation, menstruation and during childbirth, as the otherwise natural barriers against bacteria (cervix and cervix) are opened or reduced during this time. Other diseases in this area can also impair the protective function. In addition, operations (intrauterine procedures) can sometimes lead to infections.
Adnexitis is rarely a descending infection (for example, after appendicitis) or a haematogenic infection, for example in connection with tuberculosis.
With particularly severe courses, the inflammation can spread to the peritoneum (peritonitis) or lead to an abscess (tubo-ovarian abscess) and intestinal obstruction. Such complications, which are rather rare, can also be life-threatening.
Unprotected sex and poor intimate hygiene after sexual intercourse are considered risk factors for (ascending) vaginal infections. Appropriate measures can largely prevent this danger. So it is advisable to cleanse after sexual intercourse, which should preferably be done with a condom.
The clear diagnosis for adnexitis is often difficult and not every suspected case can actually be confirmed.
After a detailed medical history, the possible symptoms are examined more closely in a gynecological examination. By palpating the lower abdomen, a pressure pain of the adnexa is checked and a look at the discharge or spotting can also indicate an infection. Laboratory tests can sometimes be used to detect the pathogen using a smear, and certain parameters that indicate inflammation can also be determined in blood samples taken.
Ultrasound examinations or other imaging methods enable the detection of other signs of illness, such as fluid accumulation in the affected structures. These examination methods are also used for differential diagnosis and thus the exclusion of other clinical pictures with similar symptoms (e.g. appendicitis, ectopic pregnancy).
In the event of an unclear finding (or even after unsuccessful therapy in the chronic stage of the disease), a laparascopy (pelvis copy) should be performed, where smears can be taken directly from the fallopian tube. This abdominal mirroring is a small surgical procedure that takes place under anesthesia.
Adnexitis is a serious illness that can lead to adhesions between the fallopian tube and the ovaries without treatment or with failed therapy: This increases the risk of abscesses and also the development of larger conglomerate tumors (organ adhesions). Infertility can occur in severe and chronically recurrent diseases. Therefore, early diagnosis and subsequent specialist therapy is essential.
First and foremost, antibiotic therapy over a period of up to two weeks is necessary (with a chronic course, possibly even up to three weeks). Broad-spectrum antibiotics are primarily used to kill as many of the pathogens as possible. In more serious cases, intravenous administration and hospitalization may also occur.
Since chlamydia is also involved in around forty percent of all infections, antibiotics (including doxycycline), which have an effect on chlamydia, are often administered. If chlamydia or gonococci have been detected, partner therapy must also take place.
In addition, anti-inflammatory and analgesic drugs are prescribed for the symptoms. In order to promote healing, strict bed rest or the avoidance of any effort is recommended.
If there is no improvement despite antibiotic administration or there is a risk of complications, a diagnostic-therapeutic laparascopy may also be considered in some cases.
In addition to acute therapy and during menstruation, cold applications or after the symptoms have subsided, heat applications (fango, mud baths, hip baths with oat straw, horsetail herb and hay flower extract) can also support healing and prevent new infections.
The yarrow can have a positive effect as a tea preparation and help with the known pain during menstruation as well as with discharge. A hip bath with yarrow herb is a proven home remedy for chlamydia.
Homeopathy offers an alternative treatment option, whereby the corresponding medication must be determined depending on the symptoms and the course of the inflammation. Apis mellifica, Belladonna or Lachesis can be used.
If sufferers suffer from intestinal problems, which can also lead to an increased susceptibility to infections of the genital organs, it is advisable in the long term to clean the intestines and to clean the vaginal flora in order to better ward off infections. A healthy and high-fiber diet also contributes to this in many ways. (jvs, cs)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- Professional association of gynecologists: ADNEXITIS / SALPINGITIS / PELVIC INFLAMMATORY DISEASE (access: June 21, 2019), Frauenarzte-im-netz.de
- Independent patient counseling Germany (UPD): ovarian and fallopian tube inflammation (available: June 21, 2019), patientenberatung.de
- Pschyrembel: Clinical dictionary. 267th, revised edition, De Gruyter, 2017
- Uhl, Bernhard: Gynecology and Obstetrics compact. Thieme Verlag, 5th unchanged edition, 2013
- Janni, Wolfgang, Rack, Brigitte and Friese, Klaus (ed.): Specialist in gynecology. Urban and Fischer, 1st edition, 2008
- Bühling, Kai Joachim and Friedmann, Wolfgang: Intensive course: gynecology and obstetrics. Urban & Fischer, 1st edition, 2004
ICD codes for this disease: N70ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.